BACKGROUNDAfter successful scleral buckle and cryotherapy for macular-off retinal detachment (RD), some patients have poor visual acuity without any clinically detected macular change, and the unsatisfactory postoperative visual acuity is difficult to explain. The purpose of this study was to determine the characteristics of subretinal fluid (SRF) after successful scleral buckle surgery for macula-off RD.

METHODSTwenty-eight eyes from 28 patients were included in this study. The patients underwent scleral buckle surgery combined with cryopexy for macular-off RD. After surgery, all eyes underwent thorough ophthalmologic examinations including slit-lamp biomicroscopy, best-corrected visual acuity (BCVA) test, and binocular indirect ophthalmoscopy. The BCVA prior to the operation, duration of RD, the duration of postoperative retinal reattachment, BCVA when SRF was observed, period required for the SRF to become undetectable, and the BCVA at the final follow-up were included in the clinical data for this study. Optical coherence tomography (OCT) and B-ultrasonography were used to confirm SRF, and fluorescein angiography (FFA) was carried out in several patients. BCVA when SRF was observed and BCVA at the final follow-up were evaluated using a paired t test. Correlations between BCVA before the operation and duration of RD and BCVA at the final follow-up were analyzed using the Pearson correlation test. The type of SRF under OCT and BCVA at the final follow-up were compared using one-way analysis of variance (ANOVA).

RESULTSPostoperative retinal reattachment was achieved in 1.0 - 7.0 days (average, (2.7 ± 2.1) days). After retinal reattachment, SRF was detected in all eyes by OCT 2 weeks postoperative, while B ultrasonography found no changes. The mean logMAR BCVA was 0.35 ± 0.27 at the time of the detection of SRF. The period for SRF to become undetectable ranged from 2.0 to 11.0 months (average, (6.3 ± 2.3) months). The time of follow-up ranged from 24.0 to 36.0 months (average, (28.9 ± 3.4) months). The mean logMAR BCVA improved to 0.30 ± 0.23 at the final follow-up, which was significantly different from the mean logMAR BCVA at the time of SRF detection (paired t-test, t = 3.82, P < 0.05). Postoperative OCT images were classified into three categories. FFA was carried out in 10 eyes and revealed no leakage or strain in the lesions. BCVA before the operation was significantly correlated with BCVA at the final follow-up (r = 0.56, P < 0.05). No significant correlation was observed between BCVA at the final follow-up and duration of RD (r = 0.23, P = 0.22). One-way analysis of variance (ANOVA) showed no significant difference between the type of SRF under OCT and BCVA at the final follow-up (F = 0.21, P = 0.81).

CONCLUSIONSThe presence of persistent SRF after successful scleral buckle surgery for macular-off rhegmatogenous RD may influence the BCVA or anatomic attachment. SRF was detected in all eyes by OCT at 2 weeks after the operation. Residual detachment persisted for almost a year after surgery in certain patients. Fluorescein angiography revealed no leakage or strain in the lesions.

Adult ; Female ; Humans ; Male ; Retinal Detachment ; surgery ; Scleral Buckling ; adverse effects ; Subretinal Fluid ; secretion ; Young Adult

A 28-year-old female presented with a palpable mass lesion on the superonasal aspect of her right globe and she had a progressive diplopia. She had a scleral encircling surgery with a Miragel explant (MIRA, Waltham, Mass, USA) for the tractional retinal detachment associated with pars planitis 9 years previously. On examination, she revealed restricted eye movements of her right eye. The magnetic resonance imaging documented a swelling of the Miragel explant that mimicked a periorbital mass lesion. The Miragel explant was removed and fragmentation of the explant was found intraoperatively. The removed Miragel explant was examined by a scanning electron microscopy, and this demonstrated a disintergrated and swollen structural composition of the Miragel explant. Postoperatively, her extraocular movement was almost restored and the retina remained well attached. Alterations in the structural composition of the Miragel explant results in an excessive swelling that causes a restriction of the extraocular movement, and this can mimick a periorbital mass lesion.
Adult ; Diplopia/*etiology ; Female ; Granuloma, Plasma Cell, Orbital/*etiology ; Humans ; Magnetic Resonance Imaging ; Polyhydroxyethyl Methacrylate/*adverse effects/*analogs & derivatives ; Retinal Detachment/surgery ; Scleral Buckling/*adverse effects ; Visual Fields

OBJECTIVETo investigate corneal refractive changes after scleral buckling surgery.

METHODSIn a prospective self-controlled clinical study, we investigated the changes of refractive power, astigmatic power, astigmatic axis, and irregular astigmatic power of anterior corneal surface following scleral buckling surgery for retinal detachment in 30 patients (30 eyes). The corneal shapes were detected by Orbscan II topography at 1 day before surgery, and 1 week, 1 month, and 3 months after surgery. The effects of some surgical factors on the anterior corneal refractive changes were analyzed.

RESULTSAfter surgery, refractive power on corneal anterior surface decreased significantly in peripheral zone at 1 week (P < 0.01). Astigmatic power increased obviously in central zone. The direction of astigmatic axis matched the direction of the buckle, and changed obviously in central zone after 1 week (P < 0.05). Irregular astigmatic power did not change significantly. There was a significant correlation between the encircling length/the buckle width and the refractive changes of corneal anterior surface.

CONCLUSIONRefractive changes of corneal anterior surface following scleral buckling surgery was mainly temporary. Changes in the shape of corneal should be minimized to ensure a favorable postoperative visual acuity.

Adolescent ; Adult ; Aged ; Cornea ; pathology ; physiopathology ; Corneal Topography ; Female ; Humans ; Male ; Middle Aged ; Postoperative Period ; Prospective Studies ; Refraction, Ocular ; Refractive Errors ; etiology ; prevention & control ; Retinal Detachment ; physiopathology ; surgery ; Scleral Buckling ; adverse effects ; methods ; Time Factors

Adrenal Cortex Hormones ; therapeutic use ; Aged ; Anti-Infective Agents ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Atropine ; therapeutic use ; Dexamethasone ; therapeutic use ; Eye Infections ; complications ; drug therapy ; Female ; Fluoroquinolones ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Mydriatics ; therapeutic use ; Ophthalmia, Sympathetic ; drug therapy ; etiology ; Prednisolone ; therapeutic use ; Scleral Buckling ; adverse effects ; Triamcinolone ; therapeutic use